| Seaside Family Medicine, Llc | |
|
1341 College Park Rd # A Summerville SC 29486 | |
| (843) 400-0028 | |
| (843) 790-8449 |
| Full Name | Seaside Family Medicine, Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 1341 College Park Rd # A, Summerville, South Carolina |
| Authorized Official Name and Position | Amanda E. Mcallister (NP, OWNER) |
| Authorized Official Contact | 8434000028 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Seaside Family Medicine, Llc 1341 College Park Rd # A Summerville SC 29486-8635 Ph: (843) 400-0028 | Seaside Family Medicine, Llc 1341 College Park Rd # A Summerville SC 29486 Ph: (843) 400-0028 |
| NPI Number | 1043707557 |
|---|---|
| Provider Enumeration Date | 04/19/2018 |
| Last Update Date | 08/13/2018 |
| Medicare PECOS PAC ID | 8123374618 |
|---|---|
| Medicare Enrollment ID | O20180713002021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1043707557 | NPI | - | NPPES |
| NP2488 | Medicaid | SC |
| Provider Name | Gary F Headden |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1720196777 PECOS PAC ID: 4183705031 Enrollment ID: I20080116000598 |
| Provider Name | Amanda Elizabeth Mcallister |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1982037495 PECOS PAC ID: 5698900264 Enrollment ID: I20131107000581 |
| Provider Name | Jennifer Young |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1437521556 PECOS PAC ID: 0244533529 Enrollment ID: I20160120001094 |
| Provider Name | Lee C Ross |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1982116331 PECOS PAC ID: 8123376738 Enrollment ID: I20180730001680 |
| Provider Name | Catherine Crosby |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1316308794 PECOS PAC ID: 2466797139 Enrollment ID: I20181227002068 |
| Provider Name | Desiree R Ballesteros |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1013561182 PECOS PAC ID: 2769810001 Enrollment ID: I20200319001148 |
| Provider Name | Marcelaine Gabriele Reneau |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1841386364 PECOS PAC ID: 8921497975 Enrollment ID: I20211111002686 |
| Provider Name | Carly Rae Gruss |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1811608607 PECOS PAC ID: 9436522729 Enrollment ID: I20230308000252 |
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